Healthcare Provider Details

I. General information

NPI: 1902184930
Provider Name (Legal Business Name): ALISHA LATHAM LEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E HOUSTON ST STE 100
TYLER TX
75702-8363
US

IV. Provider business mailing address

611 GRAMMONT ST
MONROE LA
71201-7516
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-8718
  • Fax: 903-606-1218
Mailing address:
  • Phone: 318-325-2649
  • Fax: 318-388-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200452
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16076
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: